HomeMy WebLinkAbout2632 Black Fox Ct - Applications/Air Conditioner - 08/21/2017FortCityof Planning, Development, & TranspotUt/on Services
Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416,2740 Far: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). IAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photovoltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information ontheapplication. Incomplete applications will not be accepted.
Application #� -t-O� tC. '� Date g/,
Ford7ke use only
Job Site Address (mqubed) Vafu of consbvdton (labor, materials, profit)
21o�I RRrVN h IAp, ►jlIq
Owner Na 11 At ne 1l _ ., . .,,. _ It, n CYState A Zip Phone
Applicant Name
Fort Collins Heating & Air
Address
208 Commerce Dr. #4
City/State
Fort Collins, CO
Zip
80524
Phone
970.484.4552
Contractor
Address
City/State
Zip
Phone
Tort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here N Report
'We` 13X M#nM'd regUW by ad mnbecrws. Are you paying with your tnat account? J$ Yes ❑ No
/1-,1() r-4
Is this a residential orpmMial project? !X Residential ❑ Commercial
If residential, is it: GQ Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 17 Yes N Poo If yes; you may creed to contact Hrse7dc Ausermdon
If this is for a demolitlon permit, what year was the building constructed?
Description of work
— 1. PrevemRr, must nst llmnsed plumber. If first-time A/C, must list licensed elet tridan.
Subconbatt,m. LW the company name or OW of Ft CbrBns rkense 0
Elearitlan wumberMechanical H1309
Rooter Other
I hereby admowledge that I have nod this appiicatlon and state that the above information is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
Permit is not valid until a has been paid and Issued,
Applicant: AC
AtMw Signature Date
RavWm data 2VM17